Altitude and You - The Smart Traveller's Guide
We are blessed to live so close to some of the world's most beautiful mountains, and have so many places where we can trek, ski or go on a family driving trip. The clean crisp air and cool breezes are so refreshing after the heat of the plains.
However, travelling at altitudes over 2,500 metres (8,200 feet) deserves a little more respect than a normal holiday. We do not have the space to deal with the subject at length, but briefly: at these altitudes the air is thinner, meaning that there is less oxygen to breathe. This makes every task seem more difficult; you will find yourself getting tired faster. Any exertion can seem like a challenge.
Anything else?
Yes. You are likely to experience some physiological problems until your body gets used to being at higher altitudes. This ‘settling in’ is called acclimatization. The time taken to acclimatize varies from person to person – it could take anything from one to five days.
During the acclimatization period you may have any one or a combination of the following symptoms: headache, nausea, vomiting, insomnia or poor sleep, loss of appetite, lethargy and fatigue, difficulty in breathing, shortness of breath, a general feeling of malaise. A favourite symptom is flatulence! The sum of these symptoms is called ‘Altitude Sickness’ (or Acute Mountain Sickness).
Is this serious?
Acclimatization is a normal adaptive process. If you develop symptoms, they will typically pass in a few days. However, if you do not help your body to adapt (resting, and drinking plenty of non-alcoholic fluids, is key to the process, amongst other precautions), your symptoms might get worse and could develop into a serious condition.
The two most serious conditions are: HAPE - Pulmonary Oedema (fluid entering the lungs), and HACE - Cerebral Oedema (fluid entering the brain cavity).
Without getting into too much detail, in these stages the symptoms of normal Altitude Sickness get aggravated. These conditions are serious, but not fatal in themselves. If they are not immediately attended to, however, you could die.
What is the summary here?
People in good health should not be alarmed by these points, but if you have a medical condition such as high blood pressure, heart or lung disease, you must take the advice of a doctor who has experience with the effects of altitude. We do not recommend that patients with these conditions undertake trips altitude, although they should check with their healthcare professional. If you follow a regimen that includes drinking a lot of fluids (you must stay hydrated), eating well, and rest, rest, and rest, you will make a painless transition, and have a great experience. Expect a couple of unpleasant days.
You must undergo a complete medical, and get a doctor’s clearance. It would be stupid to do this trip against your doctor’s advice.
What happens if I fall sick with serious Altitude Sickness?
All of us will feel less-than-optimal for a couple of days. This is expected, and is no big deal. However, if you ignore basic advice of your trip leaders, normal Altitude Sickness may progress to advanced stages of Pulmonary Oedema or Cerebral Oedema. If this happens we must do everything to prevent the condition from deteriorating. Please keep your guides connected with how you are feeling as a group, or an individual, with no peer pressure!
You will need to have medical insurance that includes medical evacuation. If your guide feels it is necessary, he will connect with your insurance company and ensure you are medically evacuated via the medical helicopter service.
What happens if I get advanced Altitude Sickness, and the symptoms don’t subside?
If the symptoms do not subside even after the treatment (read the section on Diamox) and caution outlined above, there is only one other way to reverse altitude sickness, but luckily it’s a SURE CURE: descend to a lower altitude. We need to put you on the first plane to Mumbai or Delhi. As soon as you are at a lower altitude, the symptoms will alleviate, and will start reversing immediately. Remember that Pulmonary and Cerebral Oedema are not fatal in themselves. They can be fatal if left unattended. They are completely reversible if immediate, proper care is taken.
How is the trip planned for acclimatization?
Each trip is individually designed to assist acclimatization. Please ask us for specific details for your trip.
Can I do anything to assist acclimatization?
The process of acclimatization is very unpredictable and varies from person to person. You can help yourself by adhering to the basic rules:
Rest is critical. Do not exert yourself.
Keep yourself hydrated. Drink lots of fluids – 3 litres by 3 pm is the mantra through the day. In fact, as a general rule, if your urine has any colour, you need more liquid intake. Do not wait to feel thirsty before you drink. Keep a bottle accessible at all times. Many people make the serious mistake of keeping their fluid intake low to avoid the discomfort of getting up at night to relieve themselves. Stay off smoking and alcohol. You will probably have no desire to eat, since altitude dampens appetite, but you must force yourself to ingest at least small quantities of light food if you cannot handle a full meal.
Is there any medication you can take for altitude sickness?
MHE does not recommend you take any drugs without seeking the permission of your doctor first. Traditionally, Diamox (acetazolamide) and the homeopathic Coca 30 add some value in the prevention of Acute Mountain Sickness (AMS).
DIAMOX*
Diamox, a drug often used in the treatment of the eye condition glaucoma, is also useful in the prevention of Acute Mountain Sickness (AMS). AMS occurs commonly during visits to 3000 - 4500m and may cause a severe headache, exhaustion and general feelings of illness.
Diamox reduces the headache of AMS and helps the body acclimatize to the lack of oxygen – it also probably reduces the incidence of the complications of AMS. Whether or not one takes Diamox is obviously a matter of personal choice – travel to high altitudes is quite possible without it. Though the drug is not recommended as a routine treatment, though there is variation of opinion about this many people choose to use it if travelling quickly to altitude (eg. if flying into Leh).
How to take Diamox
Again, we advise you listen to your doctor regarding this. And if you do decide to use the drug, the standard suggested dose is Diamox 125 mg (half of one tablet) to be taken twice daily – start to take the dose 2 - 3 days before you expect to hit your highest altitude and continue until you get there. Once you reach the highest altitude of your trek, you can stop with the dose the next day. (This is as per advise received from the medical professionals situated at the Machermo Rescue Post & Porters Shelter on the way to Gokyo Lakes, Nepal). NOT FOR THOSE ALLERGIC TO SULPHA DRUGS.
Side Effects
Like all drugs, Diamox may have unwanted side effects. Tingling of the fingers, face and feet is the commonest, but this is not a reason for stopping the drug unless the symptoms are intolerable. Dizziness, vomiting, drowsiness, confusion, rashes and more serious allergic reactions have all been reported but are unusual. In exceptional cases, the drug has caused more serious problems with blood formation and/or the kidneys. Those who are allergic to the sulphonamide antibiotics may also be allergic to Diamox. More commonly, the drug makes many people feel a little “off colour”; carbonated drinks and beer also taste strange when you are taking Diamox.
*DIAMOX TEXT COPYRIGHT UIAA MOUNTAIN MEDICINE CENTRE*
IF YOU'RE DOING A HIGH ALTITUDE TREK WITH US, PLEASE DOWNLOAD, COMPLETE AND RETURN THESE 2 FORMS TO US BY EMAIL AT LEAST A WEEK BEFORE YOUR TRIP START DATE
At MHE your safety is our priority. Before any trip, we require you to provide us with details of your medical history and insurance details, as well as a signed document of release and assumption of risk.
However, travelling at altitudes over 2,500 metres (8,200 feet) deserves a little more respect than a normal holiday. We do not have the space to deal with the subject at length, but briefly: at these altitudes the air is thinner, meaning that there is less oxygen to breathe. This makes every task seem more difficult; you will find yourself getting tired faster. Any exertion can seem like a challenge.
Anything else?
Yes. You are likely to experience some physiological problems until your body gets used to being at higher altitudes. This ‘settling in’ is called acclimatization. The time taken to acclimatize varies from person to person – it could take anything from one to five days.
During the acclimatization period you may have any one or a combination of the following symptoms: headache, nausea, vomiting, insomnia or poor sleep, loss of appetite, lethargy and fatigue, difficulty in breathing, shortness of breath, a general feeling of malaise. A favourite symptom is flatulence! The sum of these symptoms is called ‘Altitude Sickness’ (or Acute Mountain Sickness).
Is this serious?
Acclimatization is a normal adaptive process. If you develop symptoms, they will typically pass in a few days. However, if you do not help your body to adapt (resting, and drinking plenty of non-alcoholic fluids, is key to the process, amongst other precautions), your symptoms might get worse and could develop into a serious condition.
The two most serious conditions are: HAPE - Pulmonary Oedema (fluid entering the lungs), and HACE - Cerebral Oedema (fluid entering the brain cavity).
Without getting into too much detail, in these stages the symptoms of normal Altitude Sickness get aggravated. These conditions are serious, but not fatal in themselves. If they are not immediately attended to, however, you could die.
What is the summary here?
People in good health should not be alarmed by these points, but if you have a medical condition such as high blood pressure, heart or lung disease, you must take the advice of a doctor who has experience with the effects of altitude. We do not recommend that patients with these conditions undertake trips altitude, although they should check with their healthcare professional. If you follow a regimen that includes drinking a lot of fluids (you must stay hydrated), eating well, and rest, rest, and rest, you will make a painless transition, and have a great experience. Expect a couple of unpleasant days.
You must undergo a complete medical, and get a doctor’s clearance. It would be stupid to do this trip against your doctor’s advice.
What happens if I fall sick with serious Altitude Sickness?
All of us will feel less-than-optimal for a couple of days. This is expected, and is no big deal. However, if you ignore basic advice of your trip leaders, normal Altitude Sickness may progress to advanced stages of Pulmonary Oedema or Cerebral Oedema. If this happens we must do everything to prevent the condition from deteriorating. Please keep your guides connected with how you are feeling as a group, or an individual, with no peer pressure!
You will need to have medical insurance that includes medical evacuation. If your guide feels it is necessary, he will connect with your insurance company and ensure you are medically evacuated via the medical helicopter service.
What happens if I get advanced Altitude Sickness, and the symptoms don’t subside?
If the symptoms do not subside even after the treatment (read the section on Diamox) and caution outlined above, there is only one other way to reverse altitude sickness, but luckily it’s a SURE CURE: descend to a lower altitude. We need to put you on the first plane to Mumbai or Delhi. As soon as you are at a lower altitude, the symptoms will alleviate, and will start reversing immediately. Remember that Pulmonary and Cerebral Oedema are not fatal in themselves. They can be fatal if left unattended. They are completely reversible if immediate, proper care is taken.
How is the trip planned for acclimatization?
Each trip is individually designed to assist acclimatization. Please ask us for specific details for your trip.
Can I do anything to assist acclimatization?
The process of acclimatization is very unpredictable and varies from person to person. You can help yourself by adhering to the basic rules:
Rest is critical. Do not exert yourself.
Keep yourself hydrated. Drink lots of fluids – 3 litres by 3 pm is the mantra through the day. In fact, as a general rule, if your urine has any colour, you need more liquid intake. Do not wait to feel thirsty before you drink. Keep a bottle accessible at all times. Many people make the serious mistake of keeping their fluid intake low to avoid the discomfort of getting up at night to relieve themselves. Stay off smoking and alcohol. You will probably have no desire to eat, since altitude dampens appetite, but you must force yourself to ingest at least small quantities of light food if you cannot handle a full meal.
Is there any medication you can take for altitude sickness?
MHE does not recommend you take any drugs without seeking the permission of your doctor first. Traditionally, Diamox (acetazolamide) and the homeopathic Coca 30 add some value in the prevention of Acute Mountain Sickness (AMS).
DIAMOX*
Diamox, a drug often used in the treatment of the eye condition glaucoma, is also useful in the prevention of Acute Mountain Sickness (AMS). AMS occurs commonly during visits to 3000 - 4500m and may cause a severe headache, exhaustion and general feelings of illness.
Diamox reduces the headache of AMS and helps the body acclimatize to the lack of oxygen – it also probably reduces the incidence of the complications of AMS. Whether or not one takes Diamox is obviously a matter of personal choice – travel to high altitudes is quite possible without it. Though the drug is not recommended as a routine treatment, though there is variation of opinion about this many people choose to use it if travelling quickly to altitude (eg. if flying into Leh).
How to take Diamox
Again, we advise you listen to your doctor regarding this. And if you do decide to use the drug, the standard suggested dose is Diamox 125 mg (half of one tablet) to be taken twice daily – start to take the dose 2 - 3 days before you expect to hit your highest altitude and continue until you get there. Once you reach the highest altitude of your trek, you can stop with the dose the next day. (This is as per advise received from the medical professionals situated at the Machermo Rescue Post & Porters Shelter on the way to Gokyo Lakes, Nepal). NOT FOR THOSE ALLERGIC TO SULPHA DRUGS.
Side Effects
Like all drugs, Diamox may have unwanted side effects. Tingling of the fingers, face and feet is the commonest, but this is not a reason for stopping the drug unless the symptoms are intolerable. Dizziness, vomiting, drowsiness, confusion, rashes and more serious allergic reactions have all been reported but are unusual. In exceptional cases, the drug has caused more serious problems with blood formation and/or the kidneys. Those who are allergic to the sulphonamide antibiotics may also be allergic to Diamox. More commonly, the drug makes many people feel a little “off colour”; carbonated drinks and beer also taste strange when you are taking Diamox.
*DIAMOX TEXT COPYRIGHT UIAA MOUNTAIN MEDICINE CENTRE*
IF YOU'RE DOING A HIGH ALTITUDE TREK WITH US, PLEASE DOWNLOAD, COMPLETE AND RETURN THESE 2 FORMS TO US BY EMAIL AT LEAST A WEEK BEFORE YOUR TRIP START DATE
At MHE your safety is our priority. Before any trip, we require you to provide us with details of your medical history and insurance details, as well as a signed document of release and assumption of risk.
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